interstitial nephritis Flashcards
what are tubulointerstitial disease ?
diseases affecting the tubules and the interstitial whilst sparing the glomerulus
is acute vs chronic interstitial nephritis reversible ?
yes , due to the preservation of basement membrane
chronic - there’s scarring and fibrosis and tubular atrophy
what are the causes of acute tubulointerstitial nephritis ?
allergic immune infections generally associated with progressive AKI after the introduction off a new drug a type of hypersensitivity reaction
what are the clinical features of acute tubulointerstitial nephritis ?
rash fever eosinophilia elevated IgE fanconi's syndrome patient may present with hematuria
what is fanconi’s syndrome ?
characterised by
glycosuria
aminoaciduria
phosphaturia
RTA
what does the renal biopsy in antibiotic induced acute tubulointerstitial nephritis show ?
shows eosinophils
occasionally ill defined granuloma
what lab changes may patients with NSAIDs induced interstitial nephritis present with ?
Nephrotic syndrome and massive proteinuria no eosinophilia and raised ALT
and have massive proteinuria with hypoalbuminemia
why is rifampicin induced interstitial nephritis different?
only ab that isn’t associated with eosinophilia
what are the lab investigation required ?
cbc with differentials
serum chemistry panel
urinalysis
what are the imaging investigations required ?
ultrasound , normal size kidney generally favors a diagnosis of acute kidney disease
what is the management for interstitial nephritis?
remove the causative agent
steroid therapy
treat any underlying disease along with supportive therapy
what is the regimen for giving steroid in AIN
methyprednisolone 1g/day day (initial pulse)
then prednisone 1 mg/kg for a period of time
predinsolone 1mg/kg for a period of time
what are the classification of interstitial nephritis ?
acute and chronic
what are the causes of chronic interstitial nephritis ?
toxins ( lead , analgesia ) infections metabolic autoimmune radiation neoplastic infiltration hereditary renal disease
what other name is given to the chronic form of interstitial nephritis ?
chronic tubulointerstitial nephritis
what is the onset of chronic tubulointerstitial nephritis
insidious onset
what is the most common category of chronic interstitial nephritis ?
analgesic nephropathy
in its most severe form what is analgesic nephropathy associated with ?
papillary necrosis in addition to chronic interstitial nephritis
what are the clincal findings of patients with analgesics nephropathy ?
renal insufficiency
modest proteinuria
sterile pyuria
anemia
what can aid the diagnosis of analgesics nephropathy ?
history of heavy use of analgesics
microcalcifications of papillary tip seen on CT
on CT there is evidence of micro calcifications at the papillary tips
what is sterile pyuria ?
presence of WBCs in the urine with no evidence of bacteria
what may the intravenous urography show in obstructive uropathy?
hydronephrosis
what is lead nephropathy commonly misdiagnosed as ?
hypertensive kidney disease
what is the classic presentation with lead nephropathy ?
hyperurecemia
gout is common
what is the most common metabolic cause of nephropathy ?
hypercalcaemia
with what diseases can hypercalcaemia happen with ?
hyperparathyroidism
multiple myeloma
vitamin d intoxication
what is a complicating factor of hypercalcaemia ?
nephrocalcinosis
renal stone formation
what is the management of chronic interstitial nephritis ?
immunosuppressive therapy kidney transplant dialysis phosphate binders calcium supplement epogen ( for the anemia)
when should we consider using steroids in cases of AIN ?
if no improvement within 3-5 days ofd removing the offending drug
what are the findings of renal biopsy of kidneys with allergic response to NSAIDs ?
minimal change nephrosis along with changes associated with interstitial nephritis
What are the drugs known to cause ATN?
b lactams
cephalosporins
fluoroquinolones
NSAIDs
Diuretics
Rifampicin
Allopurinol
PPI
What is the result of vesicoureteral reflux?
focal glomerulosclerosis with nephrotic syndrome
What kinds of stones are associated with urinary tract infections?
ammonium magnesium phosphate stones
